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PubMed1997

Emotion processing in borderline personality disorders.

The aim of this study was to examine the ways in which adults with borderline personality disorder (BPD) experience and manage their feelings. Responses of 30 subjects who met the criteria for BPD on the Structured Clinical Interview for DSM-III-R were compared with 40 non-BPD controls on the following measures of emotion processing and affect regulation: 1) level of emotional awareness, 2) capacity to coordinate mixed valence feelings, 3) accuracy at identifying facial expressions of emotion, and 4) intensity of response to negative emotions. The results showed significant differences between the two groups on all measures. The borderlines showed significantly lower levels of emotional awareness, less capacity to coordinate mixed valence feelings, lower accuracy at recognizing facial expressions of emotion, and more intense responses to negative emotions than the nonborderline controls. The findings corroborate clinical observations of borderline patients' difficulties in regulating emotions. The implications of the results for the therapeutic management of BPD patients are discussed.

Adaptation, Psychological↗
PubMed2002

Affect regulation in women with borderline personality disorder traits.

Affect dysregulation is considered a defining feature of borderline personality disorder (BPD). In spite of this, there is a dearth of empirical research that examines affect regulation among persons with BPD. The present study examined the relationship between specific dimensions of affect regulation and borderline traits in a sample of 39 patients. Participants were administered the Personality Diagnostic Questionnaire-Revised to assess the degree of borderline traits and the Affect Intensity Measure and Affect Control Scale to assess dimensions of affect regulation, selected based on the biosocial theory of BPD. Results from hierarchical regression analyses indicated that level of affect intensity and affect control were significantly associated with number of BPD traits, even after controlling for level of depression. Findings for affect control remained significant even after controlling for affect intensity. These results, consistent with biosocial theory of BPD, suggest that persons with BPD experience emotions more intensely and have greater difficulty in controlling their affective responses.

Borderline Personality Disorder↗
PubMed2001

Is electroconvulsive therapy effective for the depressed patient with comorbid borderline personality disorder?

Among the more common current indications for electroconvulsive therapy (ECT) is treatment-resistant depression. Treatment resistance is correlated with a number of factors, including the presence of comorbid personality disorders, such as borderline personality disorder (BPD). A detailed review of the literature was undertaken and very few reports or studies have dealt specifically with ECT in borderline patients. Thirteen original reports on ECT outcome in personality disordered patients were identified. Depressed patients with a personality disorder, particularly BPD, may have a poorer outcome on some measures. However, the available data suggests that depression in these patients can be effectively treated with ECT. The depressed, borderline patient appears to have two distinct disorders, one which is responsive to ECT and the other which is not. Unfortunately, the literature is limited by lack of rigorous randomized treatment studies, lack of long-term follow-up, and other methodological weaknesses. Clinical guidelines are suggested.

Borderline Personality Disorder↗
PubMed2004

Borderline personality features and instability of daily negative affect and self-esteem.

We used a daily process design and multilevel modeling to examine the role of borderline personality features in the day-to-day stability of college students' negative affect and self-esteem and their reactivity to interpersonal stressors. At the end of each day for two weeks, students completed a checklist of daily stressors and measures of state affect and self-esteem. We predicted that high scores on a measure of borderline features would be related to more daily interpersonal stressors, greater negative affective and self-esteem reactivity to these stressors, and less day-to-day carryover of negative mood and self-esteem. The first and third hypotheses were supported, but not the second. The findings demonstrate the utility of a daily process methodology and multilevel modeling to study the day-to-day functioning of individuals with borderline features.

Affect↗
PubMed1986

Characterizing paranoia in the DSM-III borderline personality disorder.

The relationship between paranoia and the borderline personality disorder continues to be the subject of debate. This study compares the extent and intensity of paranoia in 29 subjects fulfilling DSM-III criteria for borderline personality disorder. The control group consists of 22 subjects with dysthymic disorder. Paranoia was both more prevalent and severe in borderline patients. Results are discussed in light of previous descriptive and research literature.

Adolescent↗
PubMed1989

Psychodynamic features in borderline personality disorder identified by a subliminal test, the Defense Mechanism Test.

Twenty-seven psychiatric inpatients, diagnosed according to DSM-III and the Diagnostic Interview for Borderline (DIB), and 7 healthy controls were tested with the Defense Mechanism Test (DMT), a test of subliminal perception based on psychoanalytic theory. In the test a specific stimulus is presented subliminally in a tachistoscope and the patient's perceptual distortions are registered. Patients with borderline personality disorder (BPD) were compared with patients with other personality disorders, patients with schizophrenic disorders and healthy controls. Specific perceptual distortions were identified among patients with BPD. Some individual DMT signs correlated with some deviant behaviors as identified by the DIB. The findings supported the psychodynamic validity of the concept of borderline personality disorder. It is concluded that DMT is a promising research instrument that provides an empirical approach to crucial psychodynamic phenomena.

Adult↗
PubMed1990

Schizophrenic and borderline patients: introjection, relationship to mother and symptoms.

The main question of this study is: how does the psychiatrist's view of schizophrenic and borderline patients according to DSM-III relate to the patients' view of themselves in terms of their introjection ratings and their self-reported symptoms? For schizophrenic patients there is a great discrepancy between how they see themselves and how psychiatrists describe them. These patients have a most serious psychiatric diagnosis but their introjection ratings are not different from normal ratings and they also rate low levels of symptoms. Two different ways of understanding the schizophrenic patients' normal ratings are discussed. For the borderline group, the psychiatrist's view corresponds well with the patients' self-ratings. The psychiatrist and the patients agree about the patients' self-hatred and lack of self-control. Also, the borderline patients' high ratings of symptoms is very compatible with the general appearance on DSM-III of a person acting out.

Adult↗
PubMed1991

Suicide in borderline patients--predictive factors.

Twenty-one borderline patients (in accordance with Gunderson) who had committed suicide were compared with matched borderline patients who stayed alive. The suicide group had more frequent childhood loss, lack of treatment contact before hospitalization, longer hospitalization, and they were more frequently discharged for violating the treatment contract. These variables were combined into a predictive model for suicide in borderline patients.

Adult↗
PubMed1994

Building structure for the borderline construct.

This article overviews the development of the borderline personality disorder construct. In the past 25 years, the borderline personality diagnosis has grown remarkably in clinical usage even as its construct has undergone dramatic shifts in the process. It originated as a type of intrapsychic personality organization that reflected psychoanalytic observations and the hope for long-term curative therapies. It was transformed by descriptive observations into a syndrome whose boundaries with first schizophrenia and then affective disorders became the subject of intense study. More recently, it is recognized as a specific type of personality disorder that communicates substantial information about pathogenesis and that helps guide clinical planning and prognostication. The context dependency of the borderline patient's presentation explains why the diagnosis can often elude recognition.

Borderline Personality Disorder↗
PubMed1994

What are the borders of borderline personality disorder?

It is argued that the usefulness of borderline personality disorder in clinical and research practice is largely because the borders of the diagnosis are so flexible. The diagnosis overlaps with other personality disorders, disturbances of mood and intermittent abnormal behavior. As almost all behavior likely to lead to consultation with mental health professionals is included among the elements of personality disorder, it is not surprising that it is almost the most common condition seen by specialists in the field. An attempt is made to define the borders of the condition in this review. It is concluded that these are so far-reaching that they negate the notion that borderline conditions are personality disorders. It is argued that the borderline state is a coaxial diagnosis of personality and mental state disorder and to continue to describe the concept as a personality disorder is wrong and misleading.

Adjustment Disorders↗
PubMed1994

Borderline states: pharmacotherapy and psychobiology of personality. A discussion of Soloff's article.

The question of the existence of rational drug treatment of borderline personality disorder is discussed from two different positions. To the empiricists, the answer must rely on rigorous analysis of controlled drug trials, while to the realists theoretical conceptions of borderline personality disorder must also be seriously addressed. A rational pharmacotherapy can be claimed even when the nosological status of the disorder is not clarified but must be based on a dimensional analysis of psychopathology. Current psychotropic drugs have some but not any too impressive efficacy in the treatment of borderline personality disorder. It is argued that future drug treatment may benefit from the progress in neuroscience, especially within the area of psychobiology of personality.

Antidepressive Agents, Tricyclic↗
PubMedDate not supplied

Paradox as symptom in the borderline patient's struggle for self-differentiation.

TOPIC: Paradox as symptom in patients diagnosed with borderline personality disorder (BPD). PURPOSE: To conceptualize the nature of difficulties arising in psychotherapy with patients diagnosed with BPD. SOURCES: Review of the literature and clinical data from the author's work. CONCLUSIONS: The borderline dilemma is inherently paradoxical and, in some ways, reflects the human condition. Psychoanalytic concepts can further our understanding of the therapeutic difficulties encountered in the struggle to make sense of life's inherent dualities. The borderline patient is acutely sensitive to these dualities, which the therapist must tolerate and understand. Often, a negative therapeutic reaction may impede progress.

Adult↗
PubMed1986

Levels of borderline functioning in children: etiological and treatment considerations.

It has been noted frequently in the literature that the term "borderline pathology" denotes a range of disturbances. While borderline patients are characterized by severe object relations problems, there is an extremely wide range of ego functioning in these patients. Stemming from work with borderline children, this paper describes this range of varied functioning and develops inferences, based on clinical material, regarding the etiology of these differences.

Adolescent↗
PubMed1986

Selected behavioral features of patients with borderline personality traits.

Selected behavioral features felt historically and empirically to be significant in the borderline personality disorder were evaluated in 4,800 psychiatric inpatients. Variables measured included number of hospitalizations and type of discharge, suicidal behavior, physical violence, and outcome after discharge. A statistical analysis was performed to determine the relationship between depth and severity of borderline traits and the aforementioned behavioral features. Results indicated that irregular discharges, frequent suicide attempts, first suicide attempt prior to age 40, violence within and outside the hospital, and gradual deterioration in social and occupational functioning were found significantly more often in patients with high levels of borderline personality traits.

Adult↗
PubMed1990

Maintaining a balanced treatment approach with the borderline patient.

There has been an ongoing controversy in the nature of the recommended treatment for the borderline personality disorder early in therapy. Kernberg emphasizes the negative features of the transference early in therapy and recommends dealing with it primarily by interpretation, confrontation, and limit setting. Adler views the transference early in therapy as primarily reflecting subjectively perceived breakdowns in needed self-object merger, and recommends creating a symbolic holding environment through empathy and support. Gunderson devotes more equal emphasis to empathizing with and challenging the patient's point of view. The balance between empathy and confrontation is difficult to maintain because of the counter-transference pull of the borderline. In order to avoid bias toward empathic or confrontive treatment strategies, it is argued that one must pay special attention to the extent to which the therapist understands the plausibility and adaptiveness of the borderline patient's experience and behaviour as readily as the implausibility and maladaptiveness.

Borderline Personality Disorder↗
PubMed2002

Serum cholesterol and leptin levels in patients with borderline personality disorder.

The association between low or lowered cholesterol and impulsivity, aggressive behaviours and suicide remains controversial. In the present study, cholesterol and leptin levels of patients with borderline personality disorder in whom impulsivity, aggressive behaviours and suicide attempts are clearly established have been compared with those of healthy controls. The study group consisted of 16 patients with borderline personality disorder and 16 healthy controls. All patients were assessed with the Barratt Impulsivity Scale (BIS), Buss-Durkee Hostility Inventory (BDHI) and Hamilton Depression Rating Scale (HDRS). Fasting serum cholesterol and leptin levels were measured. The mean cholesterol and leptin levels of the patient group were significantly lower than those of the controls. Likewise, the patients with current suicidal thoughts and a history of suicide attempt had statistically significantly lower cholesterol and leptin levels compared with the patients without those features. There was an inverse correlation between both cholesterol and leptin levels, and impulsivity as determined by the BIS or aggression as determined by the BDHI, but no correlation between both cholesterol and leptin levels and the HDRS was found in the patients. In conclusion, the present study demonstrates that the patients with borderline personality disorder have lower cholesterol and leptin levels than healthy controls. Low serum cholesterol and leptin levels are associated with all dimensions of the disorder - impulsivity, aggression and suicidality - but are not associated with the presence and the severity of comorbid depression.

Adult↗
PubMed2005

The construct of effortful control: an approach to borderline personality disorder heterogeneity.

BACKGROUND: The present study investigated the heterogeneity of DSM-IV borderline personality disorder (BPD) diagnosis as a function of the construct of effortful control. We hypothesized 3 subgroups of BPD patients based on effortful control, that would also differ in other areas of functioning, such as symptoms, interpersonal relations and personality organization. SAMPLING AND METHODS: Forty-seven clinically referred individuals were reliably diagnosed as meeting DSM-IV criteria for BPD using semistructured interviews. Effortful control, symptomatology, interpersonal functioning and personality organization were assessed using self-report questionnaires. RESULTS: Cluster and profile analyses were performed and identified 3 subgroups. Subgroup 1, with high effortful control, exhibited the fewest problems in symptoms, interpersonal functioning and personality organization. Subgroup 3, with low ratings of effortful control, had the most problems in these areas, and subgroup 2, a group high in some aspects of effortful control but low in others, ranged midway between groups 1 and 3. DISCUSSION: The findings indicate a relationship between attentional mechanisms and the clinical expression of borderline personality pathology. Effortful control is a valuable construct for identifying subgroups of BPD patients, thus helping to understand the heterogeneity in BPD. Limitations of the study include the exclusive use on self-report of effortful control, as well as the small sample size. Future research should further investigate the associations of neurocognition and borderline pathology, as well as different approaches to treatment of the different BPD subgroups.

Adult↗
PubMed1985

Quantification of 'regressive thinking' by use of the Rorschach test. Leading symptom of the borderline syndrome?

In this study we have attempted to objectify the diagnosis of the borderline syndrome by the use of formal Rorschach testing criteria. The randomly selected protocols of 140 subjects between the ages of 17 and 25 were subjected to cluster analysis of currently accepted scoring criteria for such phenomena as prevalence of primary process thinking and disturbance of reality testing. We were unable to demonstrate a cluster of scored responses supposedly typical for the borderline syndrome. Conversely, however, the protocols of patients clinically diagnosed as borderline did show some 'typical' Rorschach signs.

Adolescent↗